基于工作流技术的放射科报告工作流程建模与实现

目前,医院正面临着与日俱增的病人就诊量,且传统管理模式和业务流程存在着诸多弊端,迫切需要管理模式的变革及业务流程的再造。近年来,工作流技术在医疗信息系统中的应用为医院业务流程再造提供了信息技术平台,医院应充分利用信息化建设契机,应用工作流技术对业务流程进行再造,建立科学的管理模式,提高工作效率和医疗质量。旨在应用工作流技术来建模并实现放射科报告流程,并阐述工作流技术应用可以解决的一系列问题及需求。     

Sharing Personal Health Information Via Service-Oriented Computing: A Case of Long-Term Care

Sharing personal health information among healthcare providers is a crucial business process not only for saving limited healthcare resources but also for increasing patient's healthcare quality. Building an effective personal health information sharing process from established healthcare systems is a challenge in terms of coordination different business operations among healthcare providers and restructuring technical details existed in different healthcare information systems. This study responds this challenge with a service-oriented approach and develops a business software application to describe how the challenge can be alleviated from both managerial and technical perspectives. The software application in this study depicts personal health information sharing process among different providers in a long-term care setting. The information sharing scenario is based on an industrial initiative, such as Integrating the Healthcare Enterprise (IHE) from healthcare domain and the technologies for implementing the scenario are Web Service technologies from Service-oriented computing paradigm. The implementation in this study can inform healthcare researchers and practitioners applying technologies from service-oriented computing to design and develop healthcare collaborative systems to meet the increasing need for personal health information sharing.     

Emergency Healthcare Process Automation Using Mobile Computing and Cloud Services

Emergency care is basically concerned with the provision of pre-hospital and in-hospital medical and/or paramedical services and it typically involves a wide variety of interdependent and distributed activities that can be interconnected to form emergency care processes within and between Emergency Medical Service (EMS) agencies and hospitals. Hence, in developing an information system for emergency care processes, it is essential to support individual process activities and to satisfy collaboration and coordination needs by providing readily access to patient and operational information regardless of location and time. Filling this information gap by enabling the provision of the right information, to the right people, at the right time fosters new challenges, including the specification of a common information format, the interoperability among heterogeneous institutional information systems or the development of new, ubiquitous trans-institutional systems. This paper is concerned with the development of an integrated computer support to emergency care processes by evolving and cross-linking institutional healthcare systems. To this end, an integrated EMS cloud-based architecture has been developed that allows authorized users to access emergency case information in standardized document form, as proposed by the Integrating the Healthcare Enterprise (IHE) profile, uses the Organization for the Advancement of Structured Information Standards (OASIS) standard Emergency Data Exchange Language (EDXL) Hospital Availability Exchange (HAVE) for exchanging operational data with hospitals and incorporates an intelligent module that supports triaging and selecting the most appropriate ambulances and hospitals for each case.     

Electronic Support for Public Health: Validated Case Finding and Reporting for Notifiable Diseases Using Electronic Medical Data

Health care providers are legally obliged to report cases of specified diseases to public health authorities, but existing manual, provider-initiated reporting systems generally result in incomplete, error-prone, and tardy information flow. Automated laboratory-based reports are more likely accurate and timely, but lack clinical information and treatment details. Here, we describe the Electronic Support for Public Health (ESP) application, a robust, automated, secure, portable public health detection and messaging system for cases of notifiable diseases. The ESP application applies disease specific logic to any complete source of electronic medical data in a fully automated process, and supports an optional case management workflow system for case notification control. All relevant clinical, laboratory and demographic details are securely transferred to the local health authority as an HL7 message. The ESP application has operated continuously in production mode since January 2007, applying rigorously validated case identification logic to ambulatory EMR data from more than 600,000 patients. Source code for this highly interoperable application is freely available under an approved open-source license at http://esphealth.org.     

持续质量改进在医疗信息系统中的应用

将持续质量改进理论引入医疗信息系统,医疗信息系统的持续改进分为成立组织、确定问题、分析原因、确定预期目标、制定实施方案、实施、检查、处理等八个子过程,在每个子过程的实施中注重全员参与,实行全方位的管理。此外,还重视环节和过程的控制。本研究在西安市某医院进行了3年试验,信息系统的质量得到明显提高。     

The application of the unified modeling language in object-oriented analysis of healthcare information systems

This paper concerns itself with the beneficial effects of the Unified Modeling Language (UML), a nonproprietary object modeling standard, in specifying, visualizing, constructing, documenting, and communicating the model of a healthcare information system from the user's perspective. The author outlines the process of object-oriented analysis (OOA) using the UML and illustrates this with healthcare examples to demonstrate the practicality of application of the UML by healthcare personnel to real-world information system problems. The UML will accelerate advanced uses of object-orientation such as reuse technology, resulting in significantly higher software productivity. The UML is also applicable in the context of a component paradigm that promises to enhance the capabilities of healthcare information systems and simplify their management and maintenance.     

信息化临床路径的应用体会

临床路径引入我国以来,迅速推广应用,在规范医疗行为、优化医疗流程、提高医疗质量等方面发挥了重要作用。近年来信息技术在医疗行业的逐步应用,使临床路径在医疗的运用走上了快车道,而电子病历系统和临床路径管理使临床业务全面信息化管理得到高度统一,针对信息化临床路径的应用推广体会进行介绍。     

医疗卫生协同流程管理

医疗卫生协同流程管理,是利用3G与互联网网络技术,以云计算架构,建立链间互动与协同的业务规则引擎,作水平／垂直协调与网状联结,为企业的讯息、协同、管理与决策中心,提供办公室及各单位问的沟通、协调、发布、通知、管理与决策等服务。     

Integration of Footprints Information Systems in Palliative Care: The Case of Medical Center of Central Georgia

Healthcare in America continues to be of paramount importance, and one of the most highly debated public policy issues of our time. With annual expenditures already exceeding $2.4 trillion, and yielding less than optimal results, it stands to reason that we must turn to promising tools and solutions, such as information technology (IT), to improve service efficiency and quality of care. Presidential addresses in 2004 and 2008 laid out an agenda, framework, and timeline for national health information technology investment and development. A national initiative was long overdue. This report we show that advancements in both medical technologies and information systems can be capitalized upon, hence extending information systems usage beyond data collection to include administrative and decision support, care plan development, quality improvement, etc. In this paper we focus on healthcare services for palliative patients. We present the development and preliminary accounts of a successful initiative in the Medical Center of Central Georgia where footprints information technology was modified and integrated into the hospital’s palliative care service and existing EMR systems. The project provides evidence that there are a plethora of areas in healthcare in which innovative application of information systems could significantly enhance the care delivered to loved ones, and improve operations at the same time..     

Doctors documenting: an ethnographic and informatics approach to understanding attending physician documentation in the pediatric emergency department

ObjectiveThe pediatric emergency department is a highly complex and evolving environment. Despite the fact that physicians spend a majority of their time on documentation, little research has examined the role of documentation in provider workflow. The aim of this study is to examine the task of attending physician documentation workflow using a mixed-methods approach including focused ethnography, informatics, and the Systems Engineering Initiative for Patient Safety (SEIPS) model as a theoretical framework.Materials and MethodsIn a 2-part study, we conducted a hierarchical task analysis of patient flow, followed by a survey of documenting ED providers. The second phase of the study included focused ethnographic observations of ED attendings which included measuring interruptions, time and motion, documentation locations, and qualitative field notes. This was followed by analysis of documentation data from the electronic medical record system.ResultsOverall attending physicians reported low ratings of documentation satisfaction; satisfaction after each shift was associated with busyness and resident completion. Documentation occurred primarily in the provider workrooms, however strategies such as bedside documentation, dictation, and multitasking with residents were observed. Residents interrupted attendings more often but also completed more documentation actions in the electronic medical record.DiscussionOur findings demonstrate that complex work processes such as documentation, cannot be measured with 1 single data point or statistical analysis but rather a combination of data gathered from observations, surveys, comments, and thematic analyses.ConclusionUtilizing a sociotechnical systems framework and a mixed-methods approach, this study provides a holistic picture of documentation workflow. This approach provides a valuable foundation not only for researchers approaching complex healthcare systems but also for hospitals who are considering implementing large health information technology projects.     

基于预制条码模式的临床实验室信息系统设计与实现

临床实验室信息系统（Laboratory Information System, LIS）是医院管理信息系统中的一个重要组成部分。以天津市肿瘤医院临床实验室信息系统的开发与应用为背景,对系统建设进行需求分析制定详细的工作流程,采用UML建立系统用例模型,采用面向对象方法完成系统架构设计,使用Cach＆#233;作为数据库和开发工具,通过全条码的流程实现与医院HIS系统无缝对接,形成一套功能比较完善的临床实验室信息系统。通过LIS系统建设,最终实现样本管理条码化,设备通讯双向化,检验流程自动化,检验报告无纸化,审核收费并网化,门诊报告取单自助化,实验室管理信息化。     

Data from clinical notes: a perspective on the tension between structure and flexible documentation

Clinical documentation is central to patient care. The success of electronic health record system adoption may depend on how well such systems support clinical documentation. A major goal of integrating clinical documentation into electronic heath record systems is to generate reusable data. As a result, there has been an emphasis on deploying computer-based documentation systems that prioritize direct structured documentation. Research has demonstrated that healthcare providers value different factors when writing clinical notes, such as narrative expressivity, amenability to the existing workflow, and usability. The authors explore the tension between expressivity and structured clinical documentation, review methods for obtaining reusable data from clinical notes, and recommend that healthcare providers be able to choose how to document patient care based on workflow and note content needs. When reusable data are needed from notes, providers can use structured documentation or rely on post-hoc text processing to produce structured data, as appropriate.     

论基于信息标准的临床数据中心构建

结合国内外医疗信息化的现状，介绍了临床数据中心的发展历程和构建框架，该框架基于HL7RIM模型表达，同时通过各种医学信息标准和HIT技术的实现，构建基于信息标准的临床数据中心体系结构和基础架构，用以实现具备统一和开放性的系统集成框架，推动医院内异构医疗信息系统的交互，并对临床数据中心在医疗信息化过程中发挥的作用和未来发展趋势进行了展望。     

Integrating Hospital Information Systems in Healthcare Institutions: A Mediation Architecture

Many studies have examined the integration of information systems into healthcare institutions, leading to several standards in the healthcare domain (CORBAmed: Common Object Request Broker Architecture in Medicine; HL7: Health Level Seven International; DICOM: Digital Imaging and Communications in Medicine; and IHE: Integrating the Healthcare Enterprise). Due to the existence of a wide diversity of heterogeneous systems, three essential factors are necessary to fully integrate a system: data, functions and workflow. However, most of the previous studies have dealt with only one or two of these factors and this makes the system integration unsatisfactory. In this paper, we propose a flexible, scalable architecture for Hospital Information Systems (HIS). Our main purpose is to provide a practical solution to insure HIS interoperability so that healthcare institutions can communicate without being obliged to change their local information systems and without altering the tasks of the healthcare professionals. Our architecture is a mediation architecture with 3 levels: 1) a database level, 2) a middleware level and 3) a user interface level. The mediation is based on two central components: the Mediator and the Adapter. Using the XML format allows us to establish a structured, secured exchange of healthcare data. The notion of medical ontology is introduced to solve semantic conflicts and to unify the language used for the exchange. Our mediation architecture provides an effective, promising model that promotes the integration of hospital information systems that are autonomous, heterogeneous, semantically interoperable and platform-independent.     

面向医学信息交换的语义查询系统设计

医疗信息工作者通过制定医学数据交换标准，实现各种纷杂独立的异构医疗信息系统间的数据共享。但由于现实医疗环境的复杂性，存在如HIs、PACS、LIS和OS等异构系统，在这些异构系统中对相同含义的对象可能存在各种不同的语言表达方式，如何识别利用这些信息以提高医疗服务质量，成为备受关注且亟需解决的问题。提出面向医学信息交换的语义查询系统，引入本体的方法来解决语义信息缺乏问题，以更好地实现医疗系统的信息交换和共享。     

Customer-Centered Careflow Modeling Based on Guidelines

In contemporary society, customer-centered health care, which stresses customer participation and long-term tailored care, is inevitably becoming a trend. Compared with the hospital or physician-centered healthcare process, the customer-centered healthcare process requires more knowledge and modeling such a process is extremely complex. Thus, building a care process model for a special customer is cost prohibitive. In addition, during the execution of a care process model, the information system should have flexibility to modify the model so that it adapts to changes in the healthcare process. Therefore, supporting the process in a flexible, cost-effective way is a key challenge for information technology. To meet this challenge, first, we analyze various kinds of knowledge used in process modeling, illustrate their characteristics, and detail their roles and effects in careflow modeling. Secondly, we propose a methodology to manage a lifecycle of the healthcare process modeling, with which models could be built gradually with convenience and efficiency. In this lifecycle, different levels of process models are established based on the kinds of knowledge involved, and the diffusion strategy of these process models is designed. Thirdly, architecture and prototype of the system supporting the process modeling and its lifecycle are given. This careflow system also considers the compatibility of legacy systems and authority problems. Finally, an example is provided to demonstrate implementation of the careflow system.     

门诊药房自动化调剂新模式的探索

传统的门诊病人取药流程繁琐，病人等待时间过长，还会引起不必要的医患纠纷。提出了一种全新的解决方法，在现有主营HIS业务系统的基础上，以外挂的形式开发了门诊语音自动司药系统，同时融合条码扫描技术，优化了门诊病人的取药流程，减少了病人等待时间，提高了药剂师的工作效率，具有很好的实际应用效果，对其它医院的信息化建设和发展也有一定的借鉴作用。     

An integrative framework for sensor-based measurement of teamwork in healthcare

There is a strong link between teamwork and patient safety. Emerging evidence supports the efficacy of teamwork improvement interventions. However, the availability of reliable, valid, and practical measurement tools and strategies is commonly cited as a barrier to long-term sustainment and spread of these teamwork interventions. This article describes the potential value of sensor-based technology as a methodology to measure and evaluate teamwork in healthcare. The article summarizes the teamwork literature within healthcare, including team improvement interventions and measurement. Current applications of sensor-based measurement of teamwork are reviewed to assess the feasibility of employing this approach in healthcare. The article concludes with a discussion highlighting current application needs and gaps and relevant analytical techniques to overcome the challenges to implementation. Compelling studies exist documenting the feasibility of capturing a broad array of team input, process, and output variables with sensor-based methods. Implications of this research are summarized in a framework for development of multi-method team performance measurement systems. Sensor-based measurement within healthcare can unobtrusively capture information related to social networks, conversational patterns, physical activity, and an array of other meaningful information without having to directly observe or periodically survey clinicians. However, trust and privacy concerns present challenges that need to be overcome through engagement of end users in healthcare. Initial evidence exists to support the feasibility of sensor-based measurement to drive feedback and learning across individual, team, unit, and organizational levels. Future research is needed to refine methods, technologies, theory, and analytical strategies.     

办公自动化系统在研究所科研信息化管理中的应用

随着网络技术和信息技术的不断发展,办公自动化(office automation, OA)系统作为一种新型办公方式,已广泛应用于管理领域。办公人员通过网络互联,可以提高工作效率,降低办公成本。本文介绍了OA系统在研究所科研信息化管理中的应用,并对其应用必要性、服务模块和管理作用等进行分析,表明在OA工作平台下可以实现信息共享,建立自动化的工作流程,有助于规范科研管理流程,提升科研管理水平,完善科研管理制度。